Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland).
Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China (mainland).
Med Sci Monit. 2019 Sep 2;25:6574-6580. doi: 10.12659/MSM.917676.
BACKGROUND In anterior cervical discectomy and fusion (ACDF) surgery, drilling operation causes a high risk of tissue injury. This study aimed to present a novel feedback system based on sound pressure signals to identify drilling condition during ACDF. MATERIAL AND METHODS ACDF surgery was performed on the C4/5 segments of 6 porcine cervical specimens. The annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and posterior longitudinal ligament (PLL) were drilled until penetration using a 2-mm high-speed burr. Sound pressure signals were collected using a microphone and dynamic signal analyzer. The recorded signals of different tissues were proceeded with lifting wavelet transform for extracting harmonic components. The frequencies of harmonic components are 1, 2, 3, 4, and 5 times higher than the motor frequency. The magnitude of harmonic components was calculated to identify different drilling conditions, along a broad spectrum of frequencies (1-5 kHz). For statistical analysis, one-way ANOVA (analysis of variance) and post hoc test (Dunnett's T3) were performed. RESULTS Very good demarcation was found among the signal magnitudes of different drilling conditions. Different drilling conditions do not present the same rate of variation of frequency. Differences in magnitude among all drilling conditions were statistically significant at certain frequency points (p<0.05). In 3 cases, one tissue could not be identified with respect to another (annulus fibrosus and endplate cartilage at 2 kHz, PLL and penetration at 3 kHz, annulus fibrosus and sub-endplate cortical bone at 5 kHz, p>0.05). CONCLUSIONS Sound pressure signals may provide an auxiliary feedback system for enhancing drilling operation in ACDF surgery, especially in minimally invasive surgery.
在颈椎前路椎间盘切除融合术（ACDF）中，钻孔操作会带来较高的组织损伤风险。本研究旨在提出一种基于声压信号的新型反馈系统，以识别 ACDF 手术中的钻孔条件。
对 6 个猪颈椎标本的 C4/5 节段进行 ACDF 手术。使用 2mm 高速磨头钻穿纤维环、终板软骨、骨皮质下终板和后纵韧带（PLL）。使用麦克风和动态信号分析仪采集声压信号。对不同组织的记录信号进行提升小波变换以提取谐波分量。谐波分量的频率比电机频率高 1、2、3、4 和 5 倍。计算谐波分量的幅度以识别不同的钻孔条件，涵盖广泛的频率范围（1-5kHz）。统计分析采用单因素方差分析（ANOVA）和事后检验（Dunnett's T3）。
不同钻孔条件的信号幅度之间有很好的区分。不同的钻孔条件没有呈现出相同的频率变化率。所有钻孔条件之间的幅度差异在某些频率点具有统计学意义（p<0.05）。在 3 个案例中，有一个组织无法与另一个组织区分开来（2kHz 时的纤维环和终板软骨，3kHz 时的 PLL 和穿透，5kHz 时的纤维环和骨皮质下终板，p>0.05）。
声压信号可能为 ACDF 手术中的钻孔操作提供辅助反馈系统，尤其是在微创手术中。
